Provider Demographics
NPI:1245445915
Name:EDWARD L. DONALDSON, JR.,DDS APDC AND JILL M DONALDSON, DDS APDC
Entity type:Organization
Organization Name:EDWARD L. DONALDSON, JR.,DDS APDC AND JILL M DONALDSON, DDS APDC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:LAWRENCE
Authorized Official - Last Name:DONALDSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:985-641-3988
Mailing Address - Street 1:2960 GAUSE BLVD E
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70461-4153
Mailing Address - Country:US
Mailing Address - Phone:985-641-3988
Mailing Address - Fax:985-646-2536
Practice Address - Street 1:2960 GAUSE BLVD E
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70461-4153
Practice Address - Country:US
Practice Address - Phone:985-641-3988
Practice Address - Fax:985-646-2536
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1880191Medicaid